NEUROCRITICAL CARE ETHICS For this reason, a higher burden of Summary: To the extent that there is family consensus in the proof of the patient’s approval such matter and the parental endorsement and presumed consent as written or spouse consent is (indicating the patient’s values) to the procedure can be often required as illustrated demonstrated, it would seem that the patient’s sister’s request for by Cornell’s guidelines. PSR can be honored and ethically acceptable. This process is in stark contrast with the standard References: of consent for organ 1. Orr RD, Siegler M. Is posthumous semen retrieval transplantation in which ethically permissible? J Med Ethics 2002;28:299-303 the benefi ciary is a third party not involved 2. Strong C, Gingrich JR, Kutteh WH. Ethics of in the consent for postmortem sperm retrieval. Human Reproduction donation process 2000;15(4):739-745 3,4. Yet, the family’s consensus 3. Hans JD, Yelland EL. American attitudes in context: on the matter is the posthumous sperm retrieval and reproduction. J Clin Res strongest argument Bioeth S1:008. Doi:10.4172/2155-9627. S1-008 indicating the patient’s values 4. Epker JL, de Groot YJ, Kompanje EJO. Ethical and and goals. practical considerations concerning perimortem sperm procurement in a severe neurologically damaged patient An analysis of and apparent discrepancy in validation of proxy consent the attitudes in various postmortem procedures. Intensive Care Med of Americans doi: 10.1007/s00134-012-2536-x with regards PSR showed that most Salvador Cruz-Flores, MD, MPH is Professor and Chair of Neurology Americans support at Texas Tech University Health Sciences Center in El Paso, Texas. PSR 3. The Michael Rubin, MD is Assistant Professor of Neurology at UT preference of the Southwestern Medical Center in Dallas, Texas. They are members of the deceased’s parents, NCS Ethics Committee. the patient’s marital status, and the patient’s likely or stated wishes increased the acceptance of PSR 3. The relatively low invasiveness of the procedure and the consent of surrogates balance the concern that the p rocedure will “violate” the respect for the dead 2. Some authors have argued about the welfare of the child. The case as presented does not provide evidence that the child’s welfare would be affected or limited given the presence of a family nucleus that is supportive 4. In this case, there is no evidence of physician or healthcare team opposition given that there is no hospital policy no law that presented restrictions to the request. Other important issues that would require some analysis include the terms of the sperm storage and how legal paternity would be decided. The Uniform Parentage Act adopted by some states established that the deceased would be presumed to be the father of the child provided that the birth occurred within 300 days of the man’s death. If the birth occurs after 300 days in those states or if it occurs in states without statutes addressing posthumous conception, then the law provides no basis for presuming that the deceased is the legal father 2. 11
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